目的    探讨适合中国肥胖病人的腹腔镜下胃旁路手术的操作流程。方法    南京医科大学第一附属医院自2010年5月至2012年5月完成腹腔镜下胃旁路术80例，其中行克利夫兰医学中心（CCF）法30例，南京医科大学（NJMU）法50例。病人均得到随访，复习所有病人手术录像，比较两组的手术时间，手术过程中体位的变换次数,操作步骤多少，术中发生的错误以及术后多余体重减少率。结果    CCF流程病人变换体位4次，NJMU流程病人变换体位2次。CCF流程手术时间平均194 min，NJMU流程手术时间平均117 min，二者之间差异具有统计学意义（P<0.01）。CCF流程中术者右手主要操作步骤共97次，NJMU流程右手操作步骤76次，二者之间差异具有统计学意义（P<0.05）。CCF流程发生2例食物支与胆胰支混淆，NJMU流程无术中肠袢混淆。两组病人术后多余体重减少率差异无统计学意义（P>0.05）。结论    经过改良优化的NJMU流程更适用中国肥胖病人，可以减少腹腔镜下胃旁路术的操作步骤，缩短手术时间，减少潜在的术中并发症。

Process optimization of laparoscopic gastric bypass operation        LIANG Hui, GUAN Wei, WU Hong-hao, et al. Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029,China
Corresponding author: LIANG Hui, E-mail: drhuiliang@126.com
Abstract    Objective    To compare two laparoscopic gastric bypass operation processes for optimization of the appropriate operation procedure for Chinese obese patients. Methods    A total of 80 obese patients underwent laparoscopic gastric bypass from May 2010 to May 2012 at the First Affiliated Hospital of Nanjing Medical University. There were two operative processes including the Cleveland Clinic Foundation (CCF) approach (n=30) and the Nanjing Medical University (NJMU) approach (n=50). All patients were followed up and surgical videos were reviewed. The operative time, the number of position change, the number of surgical steps and the number of technical errors occurred intraoperatively and postoperatively, and excess weight lose rate (% EWL) were compared between the two groups. Results    In CCF approach, position change was required 4 times, while NJMU approach required twice. The mean operative time was 117min for the NJMU approach and 194 minutes for the CCF approach, and the difference between the two approaches was statistically significant (P<0.05). The main steps with the right hand was 97 times in the CCF approach and 76 times in the NJMU approach, and the difference between the two approaches was statistically significant (P<0.05). Confusion of the food limb and biliary-pancreatic limb occurred twice in the CCF approach, while no intestinal loop confusion occurred in the NJMU approaches. The difference in EWL was not statistically significant between the two groups (P>0.05). Conclusion    The NJMU approach is more suitable for Chinese obese patients, which can reduce the steps of the laparoscopic gastric bypass, decrease operative time, minimize the potential intraoperative complications.